Hospital reforms in Albania: Assessing the transition from managerial to financial autonomy

Abstract
Aim: Albania introduced hospital autonomy through Law No. 55/2022, mandating a phased transition from managerial autonomy (2022-2025) to financial autonomy (2025-2028). We analysed the current status and implementation progress of hospital autonomy reforms in Albania.
Methods: This study consisted of a desk review which synthesized legislative and policy documents, the official hospital autonomy roadmap, and institutional reports on the implementation status of autonomy in six targeted public hospitals in Albania: the University Hospital Centre “Mother Teresa” in Tirana, the regional “Memorial” hospital in Fier, and the regional hospitals in Vlora, Durrës, Shkodër, and Lezhë.
Results: The national roadmap has identified eight priority areas (core pillars) for managerial autonomy of Albanian hospitals, each structured into two progressive levels: i) management accounting; ii) standard clinical protocols; iii) performance measurement; iv) risk management; v) patient evaluation; vi) regulation of dual practice; vii) integration of patient files into a national electronic system, and; viii) workload assessment. By January 2025, the six targeted hospitals had achieved “Level I” standards, establishing manuals, basic systems, and internal regulations. By April 2025, they advanced to “Level II standards”, operationalizing reporting, targeted training, patient satisfaction surveys, dual practice frameworks, electronic patient file use, and quantified workload assessments. By June 2025, these milestones consolidated the managerial foundation and positioned the six targeted hospitals for the phased transition to financial autonomy.
Conclusion: Albania’s gradualist approach aligns with international best practices that emphasize sequencing managerial reforms before financial autonomy. After its full implementation, Albania’s autonomy reform could transform hospitals from budget-dependent entities into self-financing institutions, while maintaining state support for essential services.

Keywords: Albania, financial autonomy, hospital autonomy, hospital reforms, managerial autonomy, public hospitals.